Thirty years ago, President Ronald Reagan deemed March to be Developmental Disabilities Awareness Month. Awareness months are an important advocacy tool, as they provide opportunities to reflect on progress and continue meaningful conversations about the future. For many people with developmental disabilities, ensuring these discussions take place can be the difference between being invisible and living as full citizens in their communities.

Developmental disabilities awareness is something near and dear to me, not only as the president of TMG by Magellan Health—supporting the largest self-directed long-term services and supports program of its kind in the country—but also because of my graduate work. During my practicum, I worked on the South side of Chicago, assisting low-income families who had children with developmental disabilities. Too often, these families, many of them single mothers, struggled to find the necessary services to help their children live as independently and inclusively as possible. The isolation the children experienced was heartbreaking.

Fortunately, in the 20 years since then, I’ve seen wonderful strides in the resources available for people with developmental disabilities, as well as greater expectations for community inclusion. Self-direction has played a crucial role in this progress. With self-direction, individuals choose not only the services they receive and who provides them, but also how they live their lives. This means people have control over things many of us take for granted: living where and with whom we want; making our own schedule; having meaningful, lasting relationships; pursuing our hobbies and passions; and finding meaningful work or volunteer opportunities. There’s been an amazing nationwide movement towards self-direction, which is not only a best practice, but also the cornerstone of TMG’s work in Wisconsin’s innovative IRIS (Include, Respect, I Self-Direct) program.

While there’s been great progress in raising expectations and increasing opportunities and resources for individuals with developmental disabilities, there’s still much to overcome on the path towards greater acceptance and inclusion. Thankfully, as community inclusion and self-direction are becoming more commonplace, society increasingly recognizes the contributions that people with developmental disabilities can make. As a leader in helping individuals create healthy, vibrant lives, Magellan Health is at the forefront of self-direction with its Wisconsin program, and is building a strong self-direction component in its new managed long-term services and supports (MLTSS) program, Magellan Complete Care of Virginia.

So as you make your way through March, take time to think about the people in your life and in your community and how we can all support one another. Learn how to be a better advocate for individuals with disabilities at sites such as ACL.gov and NACDD.org, and read stories of self-direction in TMG’s The Path Ahead. Encourage and support inclusion and independence whenever you can. But mostly, take the time to get to know people for who they are and appreciate their individual gifts and talents.

In late January, Magellan held its second annual Magellan Open Vision Exchange (MOVE) conference in Scottsdale, Ariz. MOVE brings together a large cast of voices from the healthcare industry to discuss the future of healthcare for patients, plans and providers. Over two days, we heard from private industry experts, government leaders, as well as other subject matter experts and thought leaders both from inside and outside the healthcare industry.

The Future of Healthcare Beyond the Affordable Care Act

Obviously, the continuing debate over the future of healthcare and the Affordable Care Act were a central topic of the conversation at this year’s MOVE. A number of speakers talked about the impact of the Trump Administration’s efforts to repeal the Affordable Care Act. Former Utah Governor Michael Leavitt, who also served as the secretary of the Department of Health and Human Services, said that while he expects repeal and replace legislation will pass, significant parts will be deferred for three or four years. Brian Coyne, VP of federal affairs at Magellan Health, said that he feared gridlock over the next couple of years.

Managing Transformation in the Healthcare World

One of the key topics discussed at this year’s event was the immediate future of the healthcare industry. After a long period of explosive innovation, there was consensus that disruptive change will continue. Magellan Healthcare CEO Sam Srivastava posited that we are currently in a tech-bubble that is about to burst. The industry is waiting to see which of the early healthcare technology entrants will survive and how technology and healthcare will continue to interface with each other.
Leavitt spoke extensively of the need to manage transformation, especially in healthcare. Leavitt stressed that systematic healthcare change takes hold over three to four decade cycle, and he believes we are less than mid-way through the current transformation. Using an analogy of a cattle herd, Leavitt made the point that you can’t drive a herd too quickly, or you risk a stampede. You also can’t push the herd too slowly or it will meander. Applied to healthcare, the idea is simple but true: If we push change too quickly there will be chaos, but if we fail to adapt and change, we will stagnate. Allowing ourselves to be “lulled into inaction” is a recipe for disaster.

Value-Based Healthcare

A critical area of discussion was the expansion of value-based care. Speakers agreed that demand for value-based care is accelerating. Leavitt said he believed this was true regardless of the Trump Administration’s plans for healthcare. Billy Millwee, President and CEO of BM&A Public Policy, cited broad bipartisan support for the value-based model and agreed that it was here to stay.

Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, spoke clearly on the approach that his company was taking: “We started and ended with common sense.” He went on to explain that they had built their model with the primary care physician at the center (PCP). The PCP knows the patient best and is therefore in the best position to make decisions regarding who to refer and to whom. By taking this approach, Burrell relayed, CareFirst was able to build a patient centered medical home model that improved care while reducing costs.

Despite the level of change being experienced throughout healthcare, a common theme was one of our industry being grounded in helping people get the high-quality care they need, affordably. This is the essence of why healthcare is our chosen industry and why we are driven to innovate.

An interesting takeaway was that across the conference and speakers, there was a clear common theme: while the ultimate structure of the pay-for-value transformation is uncertain, the movement will continue. Experimentation, promoted by both public and private payer initiatives, will drive innovation and change. Some will be better prepared than others to handle this paradigm shift.

The full extent of this remarkably negative 2016 Presidential campaign might surprise you. Studies show that the campaign may have had a profound effect on the mental wellbeing of many people. This goes beyond the usual split of people who feel excited or disappointed following the outcome of any election. Across the country, healthcare providers are reporting an increase in patient stress.

It should be noted, this is not simply a result of the conclusion of the campaign. In October, the American Psychological Association reported that 52 percent of American adults identified the 2016 election as a very or somewhat significant source of stress. Worryingly, that announcement was based on a survey conducted in August when the final, and most contentious, part of the campaign was just getting started.

According to the APA survey:

• Across party lines, those registered as Democrats (55 percent) and Republicans (59 percent) are statistically equally likely to say the election is a very or somewhat significant source of stress.
• Nearly 4 in 10 adults (38 percent) say that political and cultural discussions on social media cause them stress.
• Men and women are equally likely (51 percent vs. 52 percent, respectively) to say the 2016 U.S. presidential election is a very or somewhat significant source of stress.
• Millennials and “matures” are the most likely to say the election is a very or somewhat significant source of stress (56 percent vs. 59 percent, respectively) — significantly more than Generation Xers (45 percent) but not boomers (50 percent).

In fact, the APA found that people were so stressed that it saw the need to release coping tips relating to the election.

Interestingly, given the result of the election, researchers have found that stress is not just limited to liberals. In an article for Wired, Maimuna Majumder a computational epidemiology research fellow for HealthMap at Boston Children’s Hospital explained that “some findings are consistent across red, blue, and swing states. Among them is the fact that increased searches explicitly for “presidential election” seem to be associated with searches for depression and anxiety, which suggests that the 2016 presidential election cycle may have been a source of emotional distress for Americans, irrespective of political leaning.”

Where is this election stress having an impact?

Day-to-day, one of the most noticeable places where this stress is felt is in the workplace. A noticeable change in this election, compared to those in the past, is a willingness to discuss it at work. In the APA survey, nearly half (47 percent) of all respondents said people are more likely to discuss politics in the workplace this election season than in the past. With these types of discussions happening in the workplace, employers are rightfully concerned about what all of this is doing to their workforce.

In short, a high level of employee stress does not lead to an engaged, productive workforce. In fact, the result is very much the opposite. According to a study by Fairleigh Dickerson University, “Workplace stress costs U.S. employers an estimated $200 billion per year in absenteeism, lower productivity, staff turnover, workers’ compensation, medical insurance and other stress-related expenses.” Other estimates, put the number at more than $500 billion. Studies have shown that businesses with a high-stress or high-pressure environment spend as much as 50 percent more than average on healthcare. There is also a strong link between high employee stress and low employee engagement.

Supporting Employees through External Stressors

Whether it is an election or a traumatic event or emergency, there are always going to be external events that are impossible to control. It is however, feasible to provide an environment and toolkit for employees to allow them to better manage their stress levels and emotional well-being.

Employers should lean on their Employee Assistance Programs (EAP) to provide resources for employees who are feeling stressed by the election (and the rest of the news cycle). This can range from simple advice about how to manage stress to more holistic therapy options. An EAP can also provide guidance and training for management-level employees for creating a cohesive and inclusive workplace.

You’re buying a car. Before you hit the lot, you do your planning and research, establish a budget, figure out what features you want and what style you’re looking for. You probably search online for car and dealer reviews, prices and sales. Based on all of that work, you make a decision, negotiate and pay for your new car.

Your car research was relatively easy. But finding a healthcare provider? Not so much.

While you may know what you want in a provider, very little information is available about the services they provide, appointment costs, reviews and other important details to help you make an informed choice about your care. And if you ARE lucky enough to find someone who seems to fit your needs, you’re often still left wondering what kind of quality you can expect from your treatment experience.

The bottom line is that it’s easier to buy a car than it is to find a healthcare provider. Silly, right? We think so, too – which is why Magellan is bridging these information and quality gaps by employing value-based purchasing models.

Rewarding quality care yields informed choices

Value-based purchasing takes various forms. But it generally operates on the premise that aligning providers’ incentives and reimbursement with organizational and individual goals incents behavior and drives positive outcomes, ultimately benefiting all involved in the healthcare continuum. This includes consumers, customers and payers, in addition to the providers themselves, who also enjoy improved reputations through public reporting.

In fact, one of the key tenets of Magellan’s value-based collaboration and purchasing models is to ensure stakeholders become more informed as a result of these initiatives:

• Customers benefit by knowing whom to partner with for network management;
• Payers benefit by knowing whom to pay for value; and
• Consumers, of course, benefit by having those online provider reviews become a lot less elusive, enabling them to make an informed decision about whom to choose for their care.

Magellan’s models also center on:

• Engaging and empowering providers in compensation model evolution. We partner with provider leaders around compensation design, employ transparency to ease the compensation shift and create meaningful incentives for providers to encourage active engagement. (1)

• Building provider compensation for an evolving healthcare market. Our priorities center on population management, team-based care and member access. We integrate new quality and efficiency standards into compensation, and remove compensation barriers to population goals. (1)

Why do we give value-based purchasing strategies the green light?

Take our Assertive Community Treatment (ACT) program as just one example. Through program data analysis and close collaboration with our ACT provider teams, we developed a three-tiered rate structure based on overall program goals to support recovery, wellness, and to improve community tenure. As a result, we saw a 21 percent decrease in inpatient admissions and a 24 percent decrease in the inpatient readmission rate.

Our drive for engagement continues

Providers nationwide are in different phases of readiness, so we keep our wheels in motion by providing a graduated maturity model to move them from the most basic stage—learning the behavior through activity incentives—to the most complex arrangements, which transform care delivery through outcomes-based incentives or other payment structures (2). We look forward to working with stakeholders, providers and consumers as we continue to expand this innovative and exciting model.

(1) Medical Strategy Group Council: “Next-Generation Physician Composition,” The Advisory Board Company

(2) Physician Quality Reporting Initiative: The Advisory Board Company

When you think about giving back this holiday season, remember those persons serving as caregivers for the loved ones in your life.  Caregiving is one of life’s highest honors, but on the flip side it can also be physically and emotionally draining, especially during the holidays.  The added stress of having to balance holiday activities like shopping and visiting relatives and friends with caregiving responsibilities can be overwhelming, and may leave caregivers feeling frustrated, isolated, depressed and exhausted.

Caregiving today affects almost everyone – over 43 million adults in the United States have provided unpaid care to an adult or child in the past 12 months.

Bring a little joy to the world

There are a number of things you can do to help ease the burden for the caregivers in your life.  Here are some suggestions:

• Ask how you can help – This is the simplest approach. Begin by recognizing the caregiver’s role and ask about her or his concerns during the holiday season.  If you encounter resistance because the caregiver doesn’t feel that responsibilities can be set aside, make some suggestions about ways you can help without causing more stress.  For example, you could talk about family activities –are they able to attend, is the timing convenient, is there something you could do to help them prepare?
• Provide respite – Caregivers have their own holiday tasks to accomplish and more importantly, they need time to take care of themselves.  You could sit with a loved one for a few hours or help schedule in-home care for a period of time.  Perhaps spending time with the caregiver is the break they need.  Get together for coffee and companionship.
• Offer your services – With numerous responsibilities, there are bound to be a few things on the back burner that you could help a caregiver with.  Ask about needed home repairs, installing equipment to make their life easier or making a trip to the store or post office.  Could you assist with shopping or addressing holiday cards and getting them in the mail?
• Simplify traditions – Just because you’ve always done something doesn’t mean that the tradition must continue exactly as it was. Adapting activities to make them less stressful – and more enjoyable – is a win-win for everyone involved.  Plan ahead to ensure the space and timing is conducive. Something as easy as eating earlier in the day could benefit transportation arrangements, or keep caregiving needs on schedule.

Don’t limit recognition of the caregiver to the holidays.  The fact that you care enough to recognize the unique situation, the work performed, and to reach out may be enough to give the caregiver joy.  A burden shared is a burden lightened.

Keep up the good work

While holiday stress happens once a year, family caregivers are at an increased risk for burnout, depression, substance abuse, chronic illness and a host of other maladies year round.  In addition, there are a variety of caregiving situations that require special support, including long-distance caregiving and those caregivers in the sandwich generation who are caring for parents and their own children at the same time.

Check out the following tips and resources to see how you can support caregivers:

Long Distance Caregiving 

The Sandwich Generation

Finding and Choosing Respite Care Services

Caring for the Caregiver

10 Fast Facts About Caregivers

Consumerization of products continues to drive new innovations across the marketplace. For example, you can use your smartphone as a GPS device, to request a car service directly to your house and to shop for a new car online, seeing the prices other people paid in real time. In banking, we’ve seen the transition from teller to the ATM to online banking, smartphone banking and now, using your smartphone as a smart pay device. Underscoring all of these innovations is the desire to make whatever experience the consumer is engaging in easier, simpler and more personalized.

Healthcare is no different. Across the healthcare continuum, companies like ours are finding new and innovative ways to enhance member engagement and participation in the healthcare journey, particularly through computerized or mobile devices. Think about how healthcare has changed over the past 50 years – house calls from doctors to office visits to telephone triage and now, computerized therapy and text therapy.

At Magellan, we’ve invested in a unique type of computerized therapy – Computerized Cognitive Behavioral Therapy (CCBT) – to help individuals seek the therapy they need, in the comfort, convenience and privacy of their own home. Our CCBT programs were originally developed more than 20 years ago, for stand-alone personal computer use, but have since been developed for use on the internet and mobile devices, in both English and Spanish.

 The following five conditions make up more than 90 percent of behavioral health complaints in adults, and are present in more than 25 percent of adults:

• Insomnia
• Depression
• Anxiety
• Substance Abuse
• Obsessive Compulsive Disorder

Within each condition, studies have shown CCBT to be effective at reducing symptoms and severity. Importantly, our CCBT programs have undergone clinical trials involving more than 1,000 patients and have received endorsements and recognition from the American Academy of Sleep Medicine, the United Kingdom’s National Institute of Clinical Excellence, Accreditation Canada and the Substance Abuse and Mental Health Administration’s National Registry. Underscoring all of the studies and reviews, what can members expect? Sixty-nine percent of users show meaningful improvement within 30 days.

But CCBT isn’t just for members. We’ve found that providers can use a tool called Smart Screening to help screen individuals and triage them to the most appropriate levels of care on the CCBT platform, and in person, for the most serious cases. Various levels of screening can help direct individuals to CCBT, directly to an in-person counselor or a mix of both. Through this triage system, 90 percent of engaged participants rate this program as helpful and useful, and 75 percent of individuals actually prefer a non-medication care option when asked.

The most important thing about innovation in any industry – healthcare, banking or electronics – is refusing to rest on your laurels. There are new start-ups launched everyday whose mission it is to disrupt the status quo and provide new ways of doing things. As healthcare evolves, we plan to do the same.

Uncertainty is the name of the game for many industries today, including healthcare. With rapidly emerging technologies, regulations and changing consumer demands, companies must manage differently in order to keep up. Jeff Dyer, innovation visionary and co-author of the highly acclaimed, The Innovator’s DNA and its follow-on publication, The Innovator’s DNA: Mastering the Five Skills of Disruptive Innovators highlighted the threat to many companies today – predicting that 50 percent of the S&P 500 will be replaced over the next 10 years.

Human-Centered Innovation

As consumer experiences across nearly every industry become more personalized, on-demand and targeted, he encouraged pushing our thinking beyond meeting functional needs by looking at social and emotional ones as well. By doing so, companies are able to identify unmet needs that can be catalysts for more useful solutions that ultimately win in the market.

The GE Adventure Series Scanner, an MRI scanner designed for children to make scanning a less frightening experience, was a prime example shared of human-centered innovation. While advanced in functional features, what was discovered through observing young patients getting a scan was that the former machine was intimidating – the designer learning that as many as 80 percent of pediatric patients had to be sedated in order to sit still long enough for the scan.  Witnessing this, a new approach was taken, ultimately applying human-centered design methods to redesign the experience as a series of “adventures” for children, delighting and no longer scaring its young users.

The Big Picture in Quality Care

While human-centered innovation can be applied product by product and interaction by interaction, we heard another thought-provoking point from the day’s presentations – that it’s really hard to detect poor quality care through one interaction. The path to a poor outcome most likely includes bouncing from doctor to doctor and breakdowns in coordination and communication between interactions. Often, the big picture reveals the flaws.

The reality today is that many people still get prescriptions from multiple, independent physicians, and many hospital admissions come with undiagnosed behavioral health concerns. The healthcare system has an immense opportunity to come together around the whole patient and to better identify needs at a population level to deliver on value-based care that leads to healthier outcomes.

Physician Collaboration

Our physician panel sparked further ideas in how to collaborate with PCP’s, nurses and other care workers to better meet patients’ needs. Often at the front lines of the patient experience, creativity in finding unidentified needs was discussed as pivotal to creating an effective healthcare experience. While concepts of self-directed, consumer-focused healthcare and increasing consumer participation in healthcare decisions have become popular, the role of physicians is also being transformed. Their responsibility is increasingly to supplement and put into perspective available information, manage expectations, and instill confidence. The discussion thus encouraged leveraging physicians as “natural, trained problems solvers”, bringing them into the ideation for a better patient experience, and empowering them with action-oriented data and decision support along the way.

We thank all of our leaders, clients and partners for joining us in a memorable and energizing event. We look forward to our next gathering in January 2017.

The room at the inaugural Magellan Open Vision Exchange (MOVE) this past March was a sight to see. Filled with a buzz of energy and openness to think differently, Magellan executives, clients and partners gathered in shared pursuit of a better, more efficient healthcare experience of tomorrow. Collectively, the leaders in the room had impact over the healthcare experience for a significant portion of America. Yet, the focus of the conversation was clearly in how to pivot care to be more accessible and effective, one person at a time.

Help One, Help Many

The event kicked off with stories from Mick Ebeling, CEO of Not Impossible Labs, whose commitment to changing the lives of a few individuals has sparked a few of the most impactful innovations in healthcare. From his entrée into healthcare innovation with the eyewriter, helping a graffiti artist paralyzed by ALS to create art again using his eyes, to Project Daniel, a 3D prosthetic printing process that started with the goal of creating an arm for a Sudanese boy, he challenged the group to “recognize an absurdity” and then to “just commit to figuring it out.”

Neither an engineer nor a healthcare expert, his “open source” method for creating healthcare inventions turned heads. He demonstrated a commitment to designing a solution through the eyes of the individual suffering, which made all the difference in his ability to impact lives. He reminded us that he did not have all of the answers -far from it. But asserted that a key point to breaking the mold was to think of challenges as “not impossible.” He reminded us that it would be very difficult to name something that is possible today that wasn’t at one point thought of as impossible.

Healthcare as an Experience

Our client presentations continued to emphasize applications of human-centered innovation in healthcare, sharing approaches grounded in first understanding the behaviors that drive and influence healthcare experience. Key takeways included:

• Remembering that the most common reasons for a hospital stay are the more common ailments of mankind, from childbirth to respiratory and circulatory conditions, musculoskeletal conditions and mood disorders. While emphasis is often placed on advancement in rarer, more specialized conditions, a significant portion of patients can be impacted by anticipating the needs for more routine healthcare experiences.
• Listening to what’s working, and what’s not, disease state by disease state. From crowdsourcing feedback from patients to understand what helped them get better, to creating focused innovation platforms within organizations to spawn creative solutions unencumbered by traditional perceived barriers, we learned of many approaches to closing gaps in the system.
• Speaking to people successfully living with their conditions provides tremendous perspective for recovery and chronic condition management programs. When the formula isn’t as simple as issue identification + treatment = healthy, concepts like peer support become an opportunity to support living well with a physical, mental or emotional challenge by empowering the patient to learn to thrive through peer experience.
• Re-positioning healthcare leaders as “chief experimenters.” It was underscored that healthcare leaders today can’t simply focus on making decisions, they must design and enable experiments to truly push the healthcare experience forward.

Stay tuned for Part 2 of our event recap.

Looking for more information about MOVE, our gathering of healthcare innovators and thought leaders? View media and request an invitation to our January 2017 event. For questions, contact mediarelations@magellanhealth.com.